Overview

Bipolar disorder, also known as manic-depressive disorder, involves bouts of major depression and periods of mania—euphoria, poor judgment and extreme risk-taking activity—in an often-debilitating cycle. Onset usually occurs in adolescence or early adulthood. There are cases in children, but pediatric bipolar disorder presents differently from the adult form, with irritability and aggression the main symptoms of manic periods, rather than euphoria.

Until the revised DSM-5 came out in 2013, children who were chronically irritable and prone to severe tantrums were often diagnosed as bipolar, even though they did not experience these symptoms in the episodes characteristic of bipolar disorder, and they often did not go on to develop adult bipolar.  These children are now diagnosed with disruptive mood dysregulation disorder (DMDD).

Symptoms of bipolar disorder

Signs of mania:

  • Drastic personality changes
  • Excitability
  • Irritability
  • Inflated self-confidence
  • Extremely energetic
  • Grandiose/delusional thinking
  • Recklessness
  • Decreased need for sleep
  • Increased talkativeness
  • Racing thoughts
  • Scattered attention
  • Psychotic episodes-breaks from reality

Signs of depression:

  • Depressed or irritable mood
  • Loss of interest or pleasure in things once enjoyed
  • Marked weight loss or gain
  • Decreased or increased need for sleep
  • Prolonged sadness
  • Restlessness
  • Lethargy
  • Fatigue
  • Feelings of hopelessness, helplessness, worthlessness
  • Excessive or inappropriate guilt
  • School avoidance
  • Avoids friends
  • Cloudy or indecisive thinking
  • Preoccupation with death, plans of suicide, or an actual suicide attempt
  • Psychotic episodes-breaks from reality

Treatment

Medication is essential to the treatment of bipolar disorder, as is the involvement of the whole family.

Pharmacological:

The first-line medication used to treat bipolar disorder is often a mood stabilizer such as lithium and various anticonvulsants, which are generally effective at treating manic symptoms and lowering the frequency and severity of both manic and depressive episodes. Other drugs may be prescribed to treat symptoms like psychosis (antipsychotics) or trouble sleeping (anti-anxiety drugs).

Many people with bipolar disorder take more than one medication and the drugs can have complex interactions, leading to significant side effects if they are not effectively monitored by an experienced clinician.

Psychotherapeutic

Bipolar is often treated with cognitive behavioral therapy in addition to medications. CBT helps children and adolescents with the disorder understand what triggers their episodes, how their thoughts influence their feelings, and how to control and manage them. Family therapy is often employed to engage parents and other family members in keeping track of symptoms and managing stress levels in the home, which can lead to episodes.

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